HEALTH MAINTENANCE ORGANIZATION PENETRATION AND THE PRACTICE LOCATIONCHOICES OF NEW PHYSICIANS - A STUDY OF LARGE METROPOLITAN-AREAS IN THE UNITED-STATES

OBJECTIVES. The rapid growth of health maintenance organizations is re shaping the practice opportunities available to physicians. The practi ce location decisions of new physicians provide a sensitive bellwether of these changes. This study assessed the effect of health maintenanc e organization penetration on practice location for physicians complet ing graduate medical education (GME). METHODS. Conditional legit regre ssion analysis was used to determine the effect of health maintenance organization penetration on practice location, controlling for other m arket characteristics. Subjects were physicians who finished GME betwe en 1989 and 1994 and who located in one of the 98 US metropolitan area s with more than 500,000 population. The outcome measure was the parti cular metropolitan area chosen by each new physician. RESULTS. Early i n the study period, new generalists were significantly more likely to locate in metropolitan areas with high health maintenance organization penetration than in low penetration areas, whereas new specialists' p ractice location choices were not associated with health maintenance o rganization penetration. The likelihood of choosing a high penetration relative to a low penetration area declined with time, however, for b oth generalists and specialists. Consequently, by the end of the study period, health maintenance organization penetration had a weak but si gnificant negative effect on practice location for generalists and a s trong negative influence on practice location for specialists. CONCLUS IONS. New generalists who completed graduate medical education between 1989 and 1994 were more likely than new specialists to locate in mark et areas with high health maintenance organization penetration; howeve r, the proportions of both generalists and specialists who chose high penetration areas decreased during the study period. This finding may reflect reduced practice opportunities in high penetration areas relat ive to low penetration areas as health maintenance organizations' syst ems for controlling utilization began to yield results. Alternatively, new physicians may have become more hesitant to accept available posi tions in high penetration areas.